U.S. health system is performing better, though still lagging behind other countries

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The Peterson-Kaiser Health System Tracker is launching a new Health System Dashboard that will track U.S. health system performance over time across four domains: health spending, quality of care, access and affordability, and health and wellbeing. The dashboard examines trends in the U.S. health system, compares the U.S. to a group of other large and wealthy countries (“comparable counties”), and also highlights differences and disparities across demographic groups. Data in this dashboard come from a variety of sources, analyzed by Kaiser Family Foundation experts, and the tool will be updated continuously as new information becomes available.

In this post we take a step back to look at the bigger picture of what these data tell us about how well the health system is working. We find signs that the U.S. health system is improving in its ability to promote health and provide high-quality care, with some recent improvement in the accessibility of that care and a slowing of spending growth. However, the U.S. health system is not always keeping pace with similar countries, with gaps in health outcomes widening in a number of areas.

Below is a sample of findings across 10 key indicators of health system performance, with more details on each of these indicators in the dashboard (which tracks more than 50 indicators over time).

1. Life expectancy at birth has improved over the past decades, rising by more than 5 years since 1980. However, comparable countries have an average life expectancy of 82 years – 3 years longer than the U.S. life expectancy of 79 years – and the gap is growing.

2. Disease burden, a measure that accounts for both longevity and quality of life, has improved significantly over the past quarter century, dropping 16% between 1990 to 2015, with particular improvement seen for circulatory diseases. Disease burden rates are 25% higher in the U.S. than comparable countries on average, and the gap has widened slightly.

3. The rate of hospital-acquired conditions (such as adverse drug events or surgical infections) has improved, declining an estimated 21 percent from 2010 to 2015. This suggests that patient safety may have improved.

4. Thirty-day mortality following hospital admission improved in recent years for heart attack and stroke (decreasing 8% and 4%, respectively) but worsened for heart failure (increasing 6%) from 2009 – 2015. While not all deaths are preventable, lower rates of death shortly following a hospital stay may suggest care has improved. Relative to comparable countries, 30-day mortality is lower in the U.S. following hospital admissions for heart attack and stroke.

5. The rate of potentially preventable hospital admissions has improved, decreasing 23% from 2005 to 2013. Relative to comparable countries, admission rates are higher in the U.S. than in comparable countries for several diseases that could possibly be prevented, like congestive heart failure (68% higher), asthma (194%), and diabetes (38%) – though admission rates for hypertension are lower (by 24%) in the U.S relative to the average of comparable countries.

6. Due to recent gains in health coverage as a result of the Affordable Care Act, the uninsured rate among the nonelderly dropped from 18% in 2010 to 10% in 2016. Even with 91% of the total U.S. population now insured, coverage lags behind comparable countries, all of which provide essentially universal coverage.

7. Fewer adults are reporting problems paying medical bills. From 2011 to 2016, there was a 10% drop in the percent of adults reporting being worried about their ability to pay medical bills.

8. The share of Americans delaying or foregoing needed care due to costs improved, dropping from 13% in 2009 to 9% in 2015. The rates of delayed or forgone medical care for people in worse health reached an all-time low (18%) in 2015.

9. Health spending per person has grown steadily from $355 per capita in 1970 to $9,990 in 2015. More recently, from 2010 to 2015, per capita spending grew an average of 3.6% per year. Over the past five years, health spending in the U.S. has even grown more slowly than in comparable countries. On average, other wealthy countries spend about half as much per person on health than the U.S.

10. Health spending continues to grow faster than the economy, but the difference has moderated in recent years. U.S. healthcare spending accounted for 17.8% of GDP in 2015 – much more than comparable countries, where health spending averages 10.8% of GDP.

Although there is general improvement across many indicators, there are often disparities across racial or ethnic groups, genders, and income levels. Where possible, the dashboard data are broken out across demographic groups to highlight these disparities.

Some cross-national differences in health outcomes and costs may be due to a variety of social, economic, and environmental factors that influence health and are not solely or directly influenced by the health system. The dashboard includes some indicators relating to health determinants to offer context, and a separate chart collection and brief explore social determinants of health in the U.S. and comparable countries in more detail.

The dashboard is to some extent limited by what data are available at the health system level, particularly for indicators of health system quality (see our in-depth discussion here). While health spending, access, and health status data are more readily available and standardized, indicators of quality of care are less standardized and often only available nationally for the Medicare population. The quality measures included in the dashboard were selected through consultation with a number of experts in the field and present a comprehensive look at treatment outcomes, patient safety, appropriateness of treatments, use of preventive services, and the resources of the health system.

For some indicators, the dashboard is a starting point for exploring unfolding trends. It is important to keep in mind that not all indicators will change at the same pace, and data may not yet exhibit certain improvements. For example, it will take time before we can assess whether recent improvements in access and affordability of care translate into improved health outcomes.

Looking broadly at key data regarding health system performance, we see that overall, health outcomes and quality of care in the U.S. are improving in many areas, albeit often more slowly than in comparable countries. Additionally, though still much higher than comparable countries, health spending in the U.S. has moderated recently, and there has been improvement in access to care for people in worse health. Visit the dashboard for a more in-depth exploration of these other telling trends.

Methods

Data were collected and analyzed by researchers at the Kaiser Family Foundation using a variety of data sources (which can be found for specific indicators in the indicator page on the dashboard). The dashboard includes more than 50 indicators of health system performance, organized into four domains – a structure based largely on the framework put forth in the National Academy of Medicine’s 2015 Vital Signs: Core Metrics for Health and Health Care Progress. Indicators on the dashboard were selected through consultation with other experts in the field and a review of various additional sources of data on quality and outcomes measurement, including (among others): National Quality Forum; Healthcare Effectiveness Data and Information Set (HEDIS); Consumer Assessment of Healthcare Providers and Systems (CAHPS); America’s Health Rankings; Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); CMS Hospital Compare; US News and World Report; Medicare Shared Savings; and America’s Health Insurance Plans (AHIP)/CMS Core Quality Measures Collaborative; Commonwealth Fund; as well as a review of sources for data on health spending, such as the Bureau of Economic Analysis (BEA), National Health Expenditures (NHE), and the Medical Expenditure Panel Survey (MEPS).

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